Korean J Urol.  2015 Feb;56(2):164-167. 10.4111/kju.2015.56.2.164.

Ventral inlay buccal mucosal graft urethroplasty: A novel surgical technique for the management of urethral stricture disease

• Kovell RC
• Terlecki R

• KMID: 2133282
• DOI: http://doi.org/10.4111/kju.2015.56.2.164

Abstract

To describe the novel technique of ventral inlay substitution urethroplasty for the management of male anterior urethral stricture disease. A 58-year-old gentleman with multifocal bulbar stricture disease measuring 7 cm in length was treated using a ventral inlay substitution urethroplasty. A dorsal urethrotomy was created, and the ventral urethral plated was incised. The edges of the urethral plate were mobilized without violation of the ventral corpus spongiosum. A buccal mucosa graft was harvested and affixed as a ventral inlay to augment the caliber of the urethra. The dorsal urethrotomy was closed over a foley catheter. No intraoperative or postoperative complications occurred. Postoperative imaging demonstrated a widely patent urethra. After three years of follow-up, the patient continues to do well with no voiding complaints and low postvoid residuals. Ventral inlay substitution urethroplasty appears to be a safe and feasible technique for the management of bulbar urethral strictures.

Keyword

Buccal mucosa; Reconstructive surgical procedure; Urethral stricture

MeSH Terms

Cystoscopy/methods
Humans
Male
Middle Aged
Mouth Mucosa/*transplantation
Urethra/surgery
Urethral Stricture/diagnosis/*surgery
Urologic Surgical Procedures, Male/methods

Figure

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  Fig. 1 Preoperative workup. (A) Retrograde urethrogram demonstrating multifocal stricturing of the proximal bulbar urethra. (B) Cystoscopy showing narrowing and scarring of a long segment of the bulbar urethra.

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  Fig. 2 Key surgical images from ventral inlay substitution urethroplasty technique. (A) Complete exposure of the bulbar urethra with the urethra in its normal anatomic orientation (white arrow, ventral urethra). (B) Mobilized urethra rotated 180 degrees and with stay sutures in place, dorsal urethrostomy created at 12 o'clock (black arrow, dorsal urethra; white arrow, Vicryl stay stitch). (C) Dorsal urethrostomy completed along the entire length of the stricture. (D) Ventral urethral plate incised and urethral plate wings mobilized; buccal mucosal graft (BMG) sewn into place (black arrow, BMG inlay within ventral urethra). (E) Catheter placed across the area of repair (black arrow, Foley catheter). (F) Urethra closed dorsally and rotated back into anatomic position after repair (white arrow, ventral urethra).

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  Fig. 3 Postoperative voiding cystourethrogram demonstrating excellent patency of the entire urethra.

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